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Comment by rayiner | Hacker News Reader

> What do you expect me to do about it? I live in a reliably blue area and it's Republicans who are blocking things like a single-payer system.

So why did single payer healthcare fail in Vermont and California? European countries the size of Maryland manage to run their own universal healthcare systems. Why can’t states where democrats outnumber republicans 2:1 do the same?

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Because you'll get the same issue as with the homeless, people from other states will come over to mooch on the better services. This has to be handled at a national level in order for it to succeed.

Legally, I’m not sure that’s true. I think discriminating against out of staters for health insurance could well meet the compelling interest standard of Shapiro v. Johnson, similarly to how states are allowed to discriminate against out of state students for public universities. And if it were challenged, I suspect the current Supreme Court wouldn’t be so inclined to further extend the broad “right of travel” found in Shapiro.

Putting that aside, the theoretical prospect that states would have to accommodate out of state moochers doesn’t seem to be the actual reason that the California and Vermont universal healthcare efforts failed. It seems like those programs failed because voters don’t want to pay for it.

If they're homeless, they aren't 'paying' into a single payer system, regardless of it being at the State or Federal level. People that pay little to no taxes 'mooching' off the taxpayer funded services is exactly the concern of many that oppose universal healthcare.

Considering many large companies self-insure their employees' healthcare, it seems unlikely that simply expanding the scope of who is covered is going to make the whole plan work.

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